Berberine is a drug with a wide range of pharmacological effects, including anti-inflammatory, antibacterial, antiviral, anticancer, antidiarrheal, antihypertensive, hypoglycemic, and hypolipidemic effects. Its effects involve the digestive system, central nervous system, cardiovascular system, metabolic system, respiratory system, etc. In this article, the central nervous pharmacological effects of berberine such as body temperature regulation, sedation, hypnosis, anticonvulsion, and prevention and treatment of epilepsy, depression, Huntington's disease, Parkinson's disease, and schizophrenia, are reviewed to provide a reference for the clinical development of berberine in the central nervous system.

Objective: To explore the bacteriostatic effect and related mechanism of Biyan Qingdu Granules (BQG) against Staphylococcus aureus (SA), and provide a reference for the relevant clinical application of BQG. Methods: SA was inoculated on a nutrient agar plate, and a well-grown single colony of SA was taken, dissolved in physiological saline and blown evenly for later use. Liquid medium and BQG were added to the corresponding wells in a 96-well plate, and then a fixed quantity of bacterial suspension was added. The antibacterial effect of BQG on SA and its effect on the biofilm and cell membrane permeability of SA were observed. Results: The minimum inhibitory concentration of BQG for SA was 62.5 mg/mL, while the minimum bactericidal concentration was not detected. When the drug concentration of BQG was 15.625 mg/mL, the biofilm formation of SA could be inhibited significantly (P<0.01) and the 50% minimum biofilm inhibitory concentration (MBIC₅₀) of BQG was 63.125 mg/mL. The BQG at concentrations of 125-250 mg/mL had a significant inhibitory effect on the biofilm activity of SA that was cultured for 2 hours (P<0.05), while the BQG at concentrations of 3.9-250 mg/mL had a significant inhibitory effect on the biofilm activity of SA that was cultured for 4 hours and 6 hours (P<0.01). The MBIC₅₀ values of BQG for the biofilms of SA that was cultured for 2 hours, 4 hours and 6 hours were 35.762, 19.838, and 36.278 mg/mL respectively. When the drug concentration of BQG was more than 20 mg/mL, the protein content in the supernatant increased significantly (P<0.01). Conclusion: BQG has a bacteriostatic effect on SA, and its mechanism is related to interference with the biofilm formation and adhesion of SA and increase in the cell membrane permeability.

Objective: To analyze the process of anti-infective treatment and pharmaceutical care for one patient with bloodstream infection secondary to urinary tract infection caused by Staphylococcus aureus, and provide a reference for the clinical diagnosis and treatment of such patients. Methods and Results: The patient was hospitalized due to "dyskinesia". At admission, the patient had a fever. The percentage of neutrophils (NEUT%), high-sensitivity C-reactive protein (CRP) and procalcitonin (PCT) levels in the blood were abnormal, and urinalysis showed positive for white blood cells and urine protein, which was considered as urinary tract infection. Therefore, cefotaxime was empirically administered. A few days later, the patient's infection symptoms and related indicators were significantly improved. One month later, the patient had a high fever again, and the white blood cell (WBC) count, NEUT%, CRP and PCT increased again. Cefotaxime and levofloxacin were successively administered, but there was no obvious improvement. During this period, Staphylococcus aureus was detected in the urine culture. The clinician then asked the clinical pharmacist for consultation, and the clinical pharmacist recommended switching to vancomycin (1 g as the first dose, 0.5 g for maintenance, q24h) and continuing to perform the etiological examination. However, considering the patient's poor renal function, the doctor used piperacillin-tazobactam sodium. Three days later, the patient did not alleviate, and Staphylococcus aureus was also detected in the blood culture. The clinical pharmacist was asked for consultation again. In combination with the patient's renal function conditions, the clinical pharmacist recommended the vancomycin regimen again, and the doctor accepted this regimen. Five days later, the patient's WBC count, NEUT%, CRP and PCT all decreased obviously; later, because of the obvious decrease in the patient's serum creatinine level, the clinical pharmacist recommended adjusting the administration frequency of vancomycin to "0.5 g, q12h" after calculation. After the infection was basically controlled, the doctor suggested the patient to receive bladder fistulization in another hospital, taking his/her inability to urinate independently into account. Conclusion: Bloodstream infection is a relatively serious infectious disease in clinical practice. After the pathogen is basically identified, targeted anti-infective treatment should be carried out as soon as possible to control the infection as early as possible. Due to the nephrotoxicity of vancomycin, the administration dosage and frequency of vancomycin should be determined in combination with renal function conditions of patients, so as to guarantee their medication safety.

Objective: To analyze the process of anti-infective treatment and pharmaceutical care for one patient with severe Chlamydia psittaci pneumonia and secondary infection with Candida glabrata, and provide a reference for the clinical diagnosis and treatment of such complicated and severe infections. Methods and Results: The patient had symptoms such as cough, expectoration and fever half a month ago. Examinations at an external hospital showed that the infection indicators such as the white blood cell count, percentage of neutrophils, C-reactive protein, and procalcitonin were all abnormal, and the chest CT suggested lobar pneumonia. During this period, amoxicillin, ceftazidime, and levofloxacin were successively administered, but the patient's condition did not improve, so the patient was transferred to our hospital. Considering that the patient's infection was severe and the pathogen was not identified, meropenem + moxifloxacin was empirically administered. After several days of treatment, the patient did not improve, and the targeted next-generation sequencing (tNGS) revealed Chlamydia psittaci (sequence number 58 971). Therefore, the doctor added doxycycline following the advice of the clinical pharmacist, later the patient's infection symptoms and related indicators gradually improved. However, one week later, the patient's condition relapsed again. The tNGS revealed Chlamydia psittaci (sequence number 1 131) and Candida glabrata (sequence number 626). The patient was clinically considered to have a fungal infection, so voriconazole was added at the suggestion of the clinical pharmacist, and meropenem was discontinued at the same time. 10 days later, the tNGS revealed Candida glabrata only (sequence number 388), while Chlamydia psittaci was not detected, and the chest CT suggested that the lung lesions were significantly absorbed compared with before, so doxycycline + moxifloxacin was discontinued; 13 days later, the patient's various symptoms and abnormal indicators basically disappeared, achieving clinical cure; so the patient was discharged from the hospital. Conclusion: For severe infections, anti-infective treatment should be carried out as early as possible in clinical practice, and the selected antibacterial drugs should cover common pathogens as much as possible. Meanwhile, various detection methods should be used to identify the pathogens as early as possible to facilitate the development of targeted treatment. During this period, clinical pharmacists should give full play to their professional expertise, actively assist doctors in the medication regimen and help them make a more scientific treatment regimen to ensure the effective treatment of patients.

Objective: To analyze the process of anti-infective treatment and pharmaceutical care for one diabetic patient with concurrent skin and soft tissue infection and bloodstream infection, and provide a reference for the clinical treatment of secondary infections in diabetic patients. Method sand Results: The patient was hospitalized due to "skin ulcer on the right shoulder for 4 days", reported a 9-year history of diabetes with poor blood glucose control. Physical examination showed obvious necrosis and abscess in the shoulder ulcer, suggesting skin and soft tissue infection. Piperacillin-tazobactam sodium was empirically administered, combined with wound debridement and vacuum sealing drainage. On day 4, wound secretion culture results revealed Staphylococcus aureus, and drug susceptibility test showed resistance to penicillin but sensitivity to oxacillin, gentamicin, levofloxacin, erythromycin, clindamycin, vancomycin, tetracycline, etc. As the patient's infection symptoms and related indicators did not improve significantly, the anti-infective treatment regimen was adjusted to cefazolin + clindamycin. Subsequently, the patient's fever and related infection indicators gradually improved. During this period, Staphylococcus aureus was also detected in the patient's blood culture, which quickly turned negative. Conclusion: Diabetic patients with poor blood glucose control are prone to secondary skin and soft tissue infection, and severe cases may be complicated with bloodstream infection. In clinical practice, while initiating empirical treatment, etiological diagnosis should be performed as early as possible, and more targeted anti-infective treatment regimen should be formulated based on drug susceptibility test results to ensure the treatment efficacy of patients.

Objective: To analyze and identify drug-induced liver injury caused by voriconazole based on therapeutic drug monitoring and carry out the corresponding management, and provide a reference for the clinical safe use of voriconazole in pediatric patients. Methods and Results: A 10-year-old male patient (body weight: 35.5 kg) was hospitalized for the first time due to acute lymphoblastic leukemia requiring chemotherapy. During hospitalization, the patient was diagnosed with pulmonary aspergillosis and received voriconazole (300 mg, q12h). During treatment, the patient developed abnormally elevated alanine transaminase (ALT), and compound glycyrrhizin tablets were administered for liver protection, after which ALT returned to normal. One week later, the patient was re-admitted due to fever. Considering the patient's granulocytopenia and a history of liver injury, cefoperazone-sulbactam sodium and compound glycyrrhizin injection were added while continuing voriconazole treatment. However, the next day, the patient's levels of ALT and aspartate transaminase (AST) remained abnormally elevated. Tests for hepatitis viruses, TORCH antibodies, human immunodeficiency virus, syphilis, Epstein-Barr virus, etc. were performed and all results were normal. As ALT and AST levels continued to rise, ademetionine 1, 4-butanedisulfonate for injection was added, but the transaminase level continued to increase progressively. After excluding possible diseases and discontinuing multiple suspected drugs, the clinical pharmacist suspected that liver injury might be caused by voriconazole, so repeatedly suggested the blood concentration detection of voriconazole. The doctor eventually adopted this suggestion. The results showed that the blood concentration of voriconazole was 12.9 μg/mL, far beyond the recommended value; so the single dose of voriconazole was reduced from 300 mg to 150 mg, after which the transaminase level decreased significantly. Conclusion: Voriconazole may cause severe liver injury during administration. Therefore, the blood concentration of voriconazole should be routinely monitored during medication, especially when liver dysfunction has already occurred, to prevent more severe liver damage. In this case, the clinical pharmacist actively advocated for the therapeutic drug monitoring of voriconazole based on the professional knowledge, and finally ruled out the causes of liver injury, ensuring the patient's medication safety.

Objective: To analyze the clinical diagnosis and treatment process of one child with Mycoplasma pneumoniae-induced rash and mucositis (MIRM) misdiagnosed as drug-induced dermatitis, and provide a reference for the clinical diagnosis and treatment of MIRM. Methods and Results: An 8-year-old male patient initially came to our hospital due to Mycoplasma pneumoniae infection, and was treated with azithromycin and doxycycline successively, with basic control of the infection. During this period, the patient developed oral mucosal ulcers and edematous erythema on the limbs. The family sought self-treatment without improvement, so the patient was referred to a local hospital, where drug-induced dermatitis was suspected. Doxycycline was discontinued, and anti-allergic symptomatic treatment was performed, but his condition did not improve, so the patient returned to our hospital. After completing clinical examinations, combined with the patient's medical history and medication history, it was considered that the condition was not drug-induced dermatitis but MIRM. Then the treatment with azithromycin for anti-infection, methylprednisolone and human immunoglobulin for immune blockade, and other symptomatic treatments were initiated. 8 days later, most of the oral ulcers healed, the swelling and skin lesions subsided, and the pain alleviated significantly. Conclusion: MIRM is rare in clinical practice and rarely reported in China, and doctors with limited understanding of MIRM may easily misdiagnose it as drug-induced dermatitis. Therefore, clinical learning and understanding about MIRM should be strengthened to achieve correct diagnosis and ensure the effective treatment of patients.